health insurance, stories

The Chinese Hospital Story

The Chinese Hospital Story

When I lived in China back in 2006-2007 I got around mostly by bike, as did many thousands of other people in my city. I never once wore a helmet, because no one else did. And that’s why it was extremely lucky that when I eventually got into an accident I did not land on my head. (Side note: As someone who is now older, wiser, and has worked in a hospital brain injury unit, I implore you to never, ever ride a bike without a helmet.)

Instead, I landed on my tailbone. After a few seconds of sitting stunned on the concrete, I stood up and walked the couple of steps to the curb. The guy on the electric bike who had hit me stopped to see if I was okay, and I told him I was. But the next morning I was in too much pain to go to work. So I took a taxi to the hospital. My Chinese friend Sylvia met me at the hospital to translate—a kindness for which I will be forever grateful, since I didn’t know enough Chinese to communicate anything useful, other than saying the word for “bicycle” and pointing at the base of my spine.

It’s hard to convey in writing what this hospital was like. I will begin by saying it looked exactly like what I would have expected a Communist hospital in a movie to look like, with large rooms and completely bare walls. But more interesting than the hospital’s lack of wall art was its lack of concern with privacy. Soon after our arrival, Sylvia and I were sent into a large examination room where several doctors were seated at desks and at least thirty random people—other patients and their family members—were milling around. When we approached one of the doctors, about half of the other people in the room crowded in a circle around us.

Sylvia explained to the doctor in Chinese about my accident, and the doctor said something back to her. “He wants you to pull down your pants,” said Sylvia. “What?” I said. The people crowding around us watched in silence. The doctor looked at me expectantly. So…I pulled down the back of my jeans partway, just enough so the doctor, and everyone else, could see the skin around my tailbone. (To be fair, staring is not really considered rude in China the way it is in Western cultures, and I got stared at a lot while I lived there…but being stared at while being examined by a doctor was a new one.)

Another notable thing about this hospital was its payment system. Sylvia and I went to three different rooms during our visit: an examination room, an x-ray room, and a pharmacy. Each room provided me with services (or medicine) and handed me a printed bill. We took the three bills to the cashier’s office near the exit. My total for the exam, x-rays, and two medications, was (if I remember correctly) about 250 Renminbi, or the equivalent of about 33 U.S. dollars.

So I paid my bill, and I took my x-rays and medications, and said thank you to Sylvia, and went back to my apartment, where I spent the next three weeks or so sitting on an airplane neck pillow, popping pills, reading Harry Potter books #1-#6, and waiting for my tailbone to heal.

*       *       *

Why, oh why, am I telling you a story about a Chinese hospital and my tailbone on this Tuesday morning? Well, it’s because the topic I actually wanted to write about—health insurance costs—is a little dry and a little political, and I figured my Chinese hospital story might lure you into reading. And it worked. Haha.

Right, so: regarding health insurance.

From 2010 to 2015 I was enrolled in a student health plan at my university. It was fine—not great, but adequate. However, because I was graduating, it was due to disappear at midnight on Dec 31, 2015, and that meant that I needed to find something else from January 1st onward. I couldn’t get insurance through my job, because I didn’t have a job, and going without health insurance was not an option I was willing to consider. So in December I started exploring other options.

First I called my student health insurance provider and asked if I could go on COBRA. I was told, however, that my student health plan was in some kind of weird category that did not offer COBRA.

Now, I’m pretty sure that if this situation had happened in 1998, or 2002, or 2005, my only remaining option would have been to purchase a new individual health plan out of pocket—which probably would have been exorbitantly expensive. However, it wasn’t 1998, or 2002, or 2005. It was 2015. And that meant I had another option: MassHealth.

MassHealth is basically Massachusetts’s version of the Affordable Care Act, although, as you may be aware, it actually pre-dates the Affordable Care Act itself. I didn’t know much about the details of MassHealth, but a good friend of mine who had applied for it several years back told me her monthly premium had been estimated at $300, so I assumed it might be about the same for me.

So I went online, entered my information, and answered all the questions: single, unemployed, zero income. I called MassHealth to make sure I was interpreting the questions about employment correctly. Then I waited a couple days for the system to finish processing and called MassHealth again to ask what my monthly premium would be. Oh, it would be $0 per month, they said. Zero dollars. I asked the representative on the phone three times if she was sure it was free. She said yes.

Free health insurance.

I firmly believe that everyone deserves to get the healthcare they need, regardless of their financial situation, and I’ve believed for a long time that the best way to achieve this goal is for healthcare to be heavily subsidized and regulated by the government—even though this means higher taxes for me and for everyone else.

But this was the first time I had ever been an actual beneficiary of this type of system—and I was very grateful for it. MassHealth was basically a stopgap for me: I was not destitute, I had a small amount of money saved, and I knew that sooner or later I’d be able to find some sort of job. But my MassHealth benefits extended the amount of time I could support myself while searching for that job. And they made a huge difference in my peace of mind during the time that I was searching.

My apologies to anyone who didn’t think they were going to be reading a political blog post. I realize that not everyone is a fan of systems like MassHealth and the Affordable Care Act (and apologies, also, to my non-American readers for this rather American-centric post). But whatever your position on healthcare funding may be, I just wanted to share my experience with you, and you can make of it what you will.

As of this month, I’m on my new insurance through my new job. The premium is $113/month. Which I’m more than happy to pay.

PS: In case you’re wondering, the bike accident was largely my fault. I made an abrupt turn without signaling or checking to see if anyone was behind me.

PPS: You may also be wondering why a hospital located in the People’s Republic of China would employ a fee-for-service healthcare model and/or why my visit was so cheap. Unfortunately, I cannot answer either of these questions for you. My visit may have cost only $33 simply because the exchange rate at that time made everything seem super cheap; another possibility is that the fees were subsidized by the government. If you want to research the Chinese healthcare system circa 2006 and get back to me, go for it. 🙂

Thoughts?

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45 Comments

  • Reply Kalie @ Pretend to Be Poor March 8, 2016 at 9:21 AM

    It’s an interesting perspective you gained from being the beneficiary of free health insurance. I think that’s the system working as it should–as a stopgap while you found a job. Obviously there are other reasons people may need assistance. But I’m sure you will never forget how helpful that was to you when you really needed it.

    • Reply Sarah Noelle March 8, 2016 at 10:25 PM

      Yes, I’m glad that it was there. Even though it wasn’t a dire situation in my particular case, it definitely made the issue seem more real to me.

  • Reply Des March 8, 2016 at 9:45 AM

    So there’s this scene in the latest season of House of Cards (don’t worry, this isn’t a spoiler) where a Republican’s wife says to someone that surprise, she totally supports gun control, because she’s from England and they think the gun thing is ridiculous – but of course she can’t say it publicly, because she’s a political wife.

    That is basically my reaction as a Canadian to people who argue against free healthcare options. The amount of people who struggle to afford basic care in the States is unfathomable. Of *course* basic healthcare should be free. Of *course* people should not go bankrupt from trying to maintain a baseline level of health. Of *course* money should not be the reason you don’t seek medical attention. I just… like… do not even see how you can argue that only some people should be able to afford medical attention.

    But that’s just me being a crazy Canadian socialist in your comments, haha, and I even brought guns into it! POLITICS! I think my point originally is that I am so, so, so thrilled for you that you were able to get free coverage while you were looking for a job, that makes my heart so happy.

    My heart that gets free, regular medical attention.

    • Reply Sarah Noelle March 8, 2016 at 10:30 PM

      Lol, crazy Canadian socialist. It’s funny because in the U.S. a lot of people view “socialist” as a really negative term, but to me it sounds entirely positive! Or, to put it another way, this country is super divided — hence the crazy, crazy election season we have going on right now. People are so angry; I have no idea what’s going to happen. But healthcare is definitely hanging in the balance, because some of the presidential candidates are vowing to uphold Obamacare and others are vowing to dismantle it.

      I admit I don’t watch House of Cards, but I too think the gun thing is ridiculous.

      POLITICS!

  • Reply Michelle March 8, 2016 at 10:19 AM

    As a Brit who has lived in the US for 15 years, I am all for free healthcare for everyone. I’m so glad to hear that you were able to get free healthcare coverage while you were unemployed. It’s ridiculous that people do not get the treatment they need because they can’t afford it. My boyfriend’s father is currently battling an undiagnosed disease, and even though his family has good health insurance, it’s come to the point where the insurance will not cover more treatment because the doctor’s can put a name to his illness. What?! An insurance company should not have the power to dictate the course of someone’s treatment. So now Matt’s dad either has to suffer for the rest of his life or pay out of pocket to receive treatment to alleviate his symptoms. It’s crazy.

    • Reply Sarah Noelle March 8, 2016 at 10:24 PM

      I’m so sorry to hear about the situation with your boyfriend’s father. That sounds so frustrating, and so incredibly unjust. I can’t imagine what it would be like to be told something like that by an insurance company. I hope there turns out to be some way to get additional coverage. Best wishes to him and to his family.

  • Reply Lucky Girl March 8, 2016 at 12:48 PM

    Hooray for Massachusetts! We may not like it when it is -8 degrees, but they get a lot of things right here. Obviously, I don’t mind your “political” post because I happen to agree with you. But I think there are lots of people who agree that everyone should have access to a doctor at zero or low cost. I even think some of them are Republicans. It is important to have real stories out there of how MassHealth (and its federal counterpart, the ACA) truly help people. Too much of what is publicized is paid media by lobbying groups funded by special interests who benefit from the current excessively expensive system.

    • Reply Sarah Noelle March 8, 2016 at 10:20 PM

      Hooray for Massachusetts indeed! (Especially since we’re past the point of -8.) I think you’re right that there are a lot of people who are in favor of the ACA, and that there are some Republicans among them. I feel like every week on NPR I hear another report about someone who went bankrupt due to medical bills — it’s something that touches so many people’s lives, unfortunately.

  • Reply middle_class March 8, 2016 at 1:27 PM

    I think that universal healthcare should be a given and I agree that personal stories are key to making people understand its importance. It has taken many hard-fought battles to get to the current Affordable Care Act and it’s appalling to me that many corporations/politicians/lobbyists are trying to dismantle it.

    • Reply Sarah Noelle March 8, 2016 at 10:17 PM

      Yes, it has been a hard-fought battle. This election season is rather terrifying, what with candidates threatening to get rid of the ACA (among other things).

  • Reply Tawcan March 8, 2016 at 2:05 PM

    I never quite understood US medical/insurance system. Here in Canada everyone’s covered so you don’t have to worry about paying for medical care. I think that’s a way better way to do thing.

    • Reply Sarah Noelle March 8, 2016 at 10:15 PM

      Sigh, yes, many of us here in the U.S. speak wistfully of the Canadian healthcare system. (And lots of people literally drive over the border to get their meds because they’re so much cheaper in Canada!)

  • Reply Norm March 8, 2016 at 6:59 PM

    Yeah, not to get political or anything, but I’ve gone for years without buying an albuterol inhaler because of the rigmarole involved in getting one. I rarely need it, so it didn’t seem worth the bother of a doctors visit, prescription, doctor co-pay, and whatever the inhaler cost. Then while I was in Peru last year, I found myself needing an albuterol inhaler, walked into a pharmacy and bought one for $6. Without insurance in the US, it would cost $50-100, nevermind the doctor’s visit. NOT TO GET TOO POLITICAL OR ANYTHING, but that’s stupid.

    • Reply Sarah Noelle March 8, 2016 at 10:14 PM

      Haha, yes, exactly, let’s not get too political here.
      I can totally understand just not wanting to deal with the headache of trying to navigate (and pay for) getting the meds you need. It’s crazy the way healthcare/medication costs vary from provider to provider and from country to country — almost like it’s just arbitrary. I’m glad you finally got an inhaler, and for such a reasonable price!

  • Reply Maggie March 8, 2016 at 8:32 PM

    I work a ton with healthcare economics in my job. A lot of what I do is look at countries that do healthcare way better than us (ie: Sweden, Norway, etc.) and see what they are doing for certain populations of people that we are not. Luckily, Mr. T has amazing insurance through work, and I’m grateful for Obamacare which has allowed a whole bunch of people who thought they were stuck at their jobs forever retire when they wanted to or become entrepreneurs without worrying about health insurance.

    • Reply Sarah Noelle March 8, 2016 at 10:11 PM

      Oh, that sounds like such an interesting topic to get to focus on at work! I would love to learn more about that. I’m so curious about what your job is now. 🙂
      I have experience in direct patient care but would love to know more about what goes on behind the scenes in term of policy. Maybe I should go back to school and get a public health or health policy degree! (Kidding. I’ve probably had enough school.)

      • Reply Maggie March 8, 2016 at 11:19 PM

        You don’t always need more schooling to change fields. 🙂

        • Reply Sarah Noelle March 9, 2016 at 7:25 AM

          Well, that’s true. 🙂

  • Reply awkward March 8, 2016 at 8:39 PM

    Oh man, I almost snorted coffee out my nose reading about your hospital experience. I lived in Malaysia for two years (’95-97) and had several ‘group’ doctor’s appointments. People followed me down the hall into the appt room to listen in. And nod. And look concerned. The doctor spoke English to me and someone leaning in the doorway translated to Chinese-Malay so no one was left out. No big deal.

    • Reply Sarah Noelle March 8, 2016 at 9:58 PM

      Oh my gosh, no way! That actually makes me feel validated because people sometimes think I’m exaggerating when I tell this story, but it really did happen just like that! That’s so interesting to hear that you had a similar experience in Malaysia. I guess it’s just a different approach to medical care!

      • Reply awkward March 8, 2016 at 10:04 PM

        Ha! Glad I could help 🙂

  • Reply Claudia @ Two Cup House March 8, 2016 at 9:35 PM

    Free health insurance for all! Everyone deserves the right to access medical care. I really want to believe that the US will get there one day.

    • Reply Sarah Noelle March 8, 2016 at 10:06 PM

      Me too! I think/hope we’re on our way. Needless to say, this is an important election…

    • Reply Jennifer // Simply + Fiercely March 9, 2016 at 10:25 AM

      Fingers crossed!

  • Reply Jennifer // Simply + Fiercely March 9, 2016 at 10:25 AM

    As an American who has lived abroad for the past decade or so, it’s so hard for me to imagine living without a public health care system. In fact, it’s the number one reason I wouldn’t return to living in the States – it’s just too scary (a bit like your helmet thing, I didn’t worry when I was younger but now that I’m approaching 35 I think a lot differently!)

    However, it is interesting to hear a firsthand story about MassCare and the Affordable Care Act. It’s something I don’t fully understand as I’ve been away, but it’s sounds like a step in the right direction. Congrats again on the new job and woo hoo for health insurance! 🙂

    • Reply Sarah Noelle March 9, 2016 at 11:48 PM

      I agree — it is scary. I’ve heard a lot of stories about people who went bankrupt due to healthcare costs. The current administration has, in my opinion, done a great deal of good by creating a better/kinder system, but as you may have heard, several of the current presidential candidates are threatening to dismantle the ACA if they get elected. Very scary.

  • Reply enancejividen March 9, 2016 at 10:31 AM

    We have an ACA policy and I’m pretty concerned what will happen if the Republicans get the opportunity to dismantle ACA. It’s not like our policy is cheap for the 3 of us, even with the subsidy, and it went up from about $350 a month out of pocket to about $550 a month this year with inferior coverage. (our old plan wasn’t even available)

    But we definitely can’t go without insurance. NC is not a state where there’s much of a social net, and much of what has been available has shrunk in the last few years. Certainly, we’re concerned about the future, because even if Jon or I moves into a job with insurance, we are a lot more aware of the conditions for those without that luxury.

    • Reply Sarah Noelle March 9, 2016 at 11:51 PM

      It’s so interesting how much things differ from state to state. I’ve thought a lot about how my situation might be different if I didn’t live in Massachusetts. And yeah, it’s definitely a scary election year: a lot of things, including the ACA, are hanging in the balance.

  • Reply Broke Millennial March 10, 2016 at 12:04 PM

    I didn’t know you lived in China! We overlapped. I lived in Japan from 2000 – 2005 and Shanghai, China from 2005 – 2007 (I graduated high school there). I can certainly empathize with the gawking and experience with Chinese hospitals. Quite a different style from those here in America.

    • Reply Sarah Noelle March 10, 2016 at 6:13 PM

      Oh, no way — I actually lived in Suzhou, so we were super close geographically! How interesting that you graduated high school there; I would love to hear more about that.

  • Reply Jen @ Frugal Millennial March 13, 2016 at 6:06 PM

    I think there are some great benefits of the ACA and it’s awesome that you were able to access free health insurance during a brief period of unemployment. Not to get too political or anything, but I personally feel some changes should be made to the ACA. The most frustrating thing to me is that only income is considered when calculating whether or not coverage is “affordable” for you. My husband and I have “good” incomes, but because we’re buried in six figure student loan debt, we don’t make enough to get by.

    I had a brief period of unemployment and decided to go without health insurance for a couple of months because I couldn’t afford expensive private insurance. (I didn’t qualify for assistance because of my husband’s income – his massive student loan debt and mine were not factored in). The idea of having to pay a penalty (I didn’t have to because I only went without insurance for a couple months) for going without something I couldn’t afford is frustrating. Again, I think there are benefits of the ACA but they could look at more than just income alone.

    • Reply Sarah Noelle March 14, 2016 at 5:51 PM

      Thanks for sharing this — I hadn’t thought of that aspect of it before. (I do have student loans, but since I didn’t have an income when I applied, I didn’t run into this issue.) There are so many people who have student loans that it seems as though they should be taken into account somehow, especially if it’s federal loans we’re talking about. But even if the loans are private, I can totally see your point. Since the ACA is so new, maybe there will be changes like this along the way as it continues to evolve.

  • Reply LeisureFreak Tommy March 14, 2016 at 12:54 PM

    Great story. My early retirement budget is around $40K a year and out of that a little over $10K is medical insurance premiums. On top of that we had another $2K out of pocket medical cost not covered by insurance as part of our deductibles in 2015. Seems hard to believe that 30% of my budget is just medical related.

    • Reply Sarah Noelle March 14, 2016 at 5:59 PM

      Wow, 30% is a pretty big chunk. I’m curious to know why you wouldn’t be able to get a plan for under $10K, if you’re technically not making any/much money in retirement, but I guess everyone’s situation is different. Our Next Life had an interesting post recently about navigating health insurance costs in early retirement; you might find it interesting if you haven’t already seen it: http://ournextlife.com/2016/02/01/the-moral-ambiguity-of-obamacare-subsidies-for-early-retirees/

  • Reply our next life March 15, 2016 at 2:37 AM

    I read this post last week, but had so many thoughts about it, I couldn’t quite get them all together at one time. Not sure I’ll do any better now, but I’ll at least give it a shot. 🙂 First, your Chinese hospital story is crazy! Thank goodness your friend was there to translate, but it sound harrowing either way. And yet, so cheap. It’s so hard to understand how something that is essentially an interchangeable commodity can very so vastly in price, even in the same U.S. city. We definitely need, at a minimum, some price transparency around health care here at home. But, okay, bigger point — It makes me super sad that the state of our country is such that you feel like you can’t just write a post about how you’re taking care of your health without it feeling like you might alienate readers or trigger some political warfare. It’s health care. It should be a basic human right. It makes me all kinds of sad and angry that it’s become so heavily politicized, and taking the health care coverage that you’re entitled to by law (and which, by the way, benefits us all economically, because it’s far cheaper to subsidize health care for people than to pay rack rate for uninsured people to show up at emergency rooms with no way to pay) feels like some kind of political statement. Sigh. We live in a weird time — that’s not news. But this should be such a non-thing. “I’m looking for a job, and this is what you do while you’re looking for a job.” End of story. So that’s how I’m seeing it — not as a topic that needs a preface story to sugar coat it, but just as a totally normal thing that regular, non-welfare-frauding people do because it only makes sense. 🙂

    • Reply Sarah Noelle March 15, 2016 at 8:40 PM

      It’s funny, this blog post actually evolved because I’d been toying with the idea of writing about the Chinese hospital story for a while, but couldn’t figure out how to make it into a full post, and then I realized I also had about a half post’s worth of thoughts about my healthcare situation, so I figured I’d just do a mash-up and lead with the hospital story because it’s funnier. But it’s also true that I tend to shy away from writing about controversial topics here on the blog — that’s something I aspire to be braver about (thank YOU for setting a good example!). And regarding your point about how healthcare should be a non-thing, I agree wholeheartedly! Unfortunately there are millions of people who angrily beg to differ. 🙁

      On an only slightly tangential note, I happened to run across this amusing article the other day: http://reason.com/blog/2015/09/29/donald-trump-wants-to-repeal-obamacare-r

      • Reply our next life March 15, 2016 at 9:28 PM

        That’s cool to know that it was that story that was the genesis of this blog! And that link… Oh, Trump. :::face palm:::

  • Reply Andrew@livingrichcheaply March 15, 2016 at 11:35 AM

    You definitely lured me in with that title…interesting story. Living in the richest country here in the US, it really is odd that we don’t have certain things that seem like such a rich country should have. Sure, as Jen above mentioned, there are issues with ACA but one reason is because there were many compromises that had to be made from the original plan to get it pass Congress. I’ve been fortunate as an adult to have had great health insurance coverage but growing up that wasn’t the case. Luckily, there were no catastrophes but we rarely sought medical help unless it was absolutely necessary!

    • Reply Sarah Noelle March 15, 2016 at 8:47 PM

      Ah, that’s a good point about compromises in the ACA that had to be made in order for it to be passed. It is really surprising to me how many people are vehemently against the ACA — I feel like it was lucky that it did actually pass. Now I’m crossing my fingers that it doesn’t get dismantled over the next four years.

  • Reply Vic @ Dad is Cheap March 16, 2016 at 3:59 PM

    $33! Wow. I’m sure in the US that bill would be $1000! One time when I had a job but crappy insurance my trip to the emergency room cost $1300. Crazy.

    I’m glad you got free health care. That’s what it’s for. 🙂

    • Reply Sarah Noelle March 16, 2016 at 8:20 PM

      Oh gosh, I’m so sorry — $1300 to go to the emergency room is a lot. 🙁
      I don’t know what was up with that bill in China; I wish I’d kept a copy of it!

  • Reply Jessica in Canada March 21, 2016 at 8:44 PM

    I am Canadian, so I am not going to add to the comments that OF COURSE universal healthcare is the best. My comment is on a slightly different tangent…FYI for Sarah and anyone else who this may apply to: if you injure your tailbone (or coccyx is the technical term) you must must must go to a physiotherapist who specializes in that area! A doctor or physiotherapist who that is not their specialty will help you nothing! They give you pain meds and then it will heal in the wrong spot and at best it will take way longer to feel better and at worst you will have pain for the rest of your life.

    A physiotherapist needs to MANUALLY put it back into place. (Don’t worry, it’s not painful.) The sooner you can get to physio, the better, before scar tissue forms. I have dislocated my coccyx SIX TIMES (four through childbirth) so I tell you this out of experience. If you have any residual pain, you re-injure it, or you have a baby, GO to physio. It is worth every penny for the immediate relief, not to mention a life free of pain. (Incidentally in Canada since this is not covered, I paid for $75 for the first visit, and $55 for subsequent visits, and I usually only had to go once or twice. Little did they know I actually would have paid my life’s savings the pain is so awful!)

    • Reply Sarah Noelle March 22, 2016 at 8:16 PM

      Wow, Jessica, thanks for sharing about your experiences with this. I think that fortunately I did not actually fracture or dislocate my tailbone — the Chinese radiologist told me he thought there was a hairline fracture, but when I sent the x-rays to my doctor in the U.S. she said she didn’t see anything, so it may have been just bruised. But it’s definitely good to know about this. I feel really lucky now that I escaped without residual pain (this happened 8 years ago, so I think I’m in the clear).

      • Reply Jessica in Canada March 22, 2016 at 9:40 PM

        Ah yes, that is true — a hairline fracture or a bruise is extremely painful as well, but doesn’t need to be put back into place! Glad it healed for you!

        • Reply Sarah Noelle March 23, 2016 at 6:22 AM

          Thanks, me too!

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